Psoriasis is a chronic inflammatory skin condition with many associated co-morbidities, making timely diagnosis key in patient care. This study investigates racial, ethnic, gender, and insurance disparities in the time to diagnosis of psoriasis in adolescent patients. It is hypothesized that health disparities will lead to increased time to diagnosis in patients of color and those with no insurance or public insurance as compared to private insurance. Retrospective chart review of consecutive patients (n=83) diagnosed with psoriasis between 2012 and 2022 was conducted. The study found a considerable delay in time to diagnosis for pediatric patients, averaging 371.5 days. Females exhibited longer times to diagnosis than males. This prolonged period can lead to increased physical discomfort and a greater risk of developing complications. While no statistically significant differences were found based on race or ethnicity, patients with no insurance experienced significantly longer times to diagnosis compared to their insured counterparts. Patients with a previous misdiagnosis (i.e., eczema, fungal infection, atopic dermatitis) had significantly longer times to diagnosis as well. The fact that race and ethnicity did not significantly influence time to diagnosis suggests strides in reducing health disparities within medical institutions. However, the fact that social determinants of health significantly influenced time to diagnosis suggests that low socioeconomic status correlates to delayed diagnoses and poorer health outcomes, highlighting the need for more equitable access to timely medical care for uninsured populations. Overall, this study contributes valuable insights into health disparities affecting time to diagnosis of psoriasis in adolescent patients.

The rising prevalence of pediatric food allergies represents a growing public health concern, with hospitalizations for food-induced anaphylaxis on the rise. Early cutaneous manifestations, particularly in the setting of atopic dermatitis (AD), may indicate sensitization via the skin—a critical route for allergen exposure in early life. Pediatric food allergies can be IgE-mediated, non-IgE-mediated, or mixed, with each type presenting distinct pathophysiological and clinical features. IgE-mediated reactions often involve acute urticaria and angioedema, while non-IgE forms, such as food protein-induced enterocolitis syndrome (FPIES), manifest with delayed gastrointestinal symptoms and limited skin involvement. AD is closely linked with food allergies, both in pathogenesis and symptom exacerbation, with a high prevalence of co-occurrence. Diagnosis primarily relies on clinical evaluation, supported by testing such as skin prick testing, serum IgE, and oral food challenges, though limitations exist in sensitivity and specificity. Management emphasizes allergen avoidance, symptom control, and multidisciplinary care. While many pediatric food allergies resolve with age, others persist or present chronically, necessitating long-term strategies. Coordinated management between allergy and dermatology is key to minimizing complications and supporting better long-term outcomes for affected children.

Introduction: Secondary syphilis, also termed the great mimicker due to its vast array of clinical presentations, is associated with skin manifestations including rupioid, macular, psoriasiform, and condylomatous lesions. On clinical examination alone, it can be difficult to differentiate between rupioid syphilis and rupioid psoriasis, especially among cases of human immunodeficiency virus (HIV) and syphilis co-infection; however, histologic examination can aid in their differentiation. Additional testing such as serum rapid plasma reagin (RPR), anti-HIV antibody, rheumatoid factor, and fungal cultures should be performed to exclude other causes of rupioid lesions. Case Report: A 19-year-old HIV-positive male developed numerous hyperkeratotic skin lesions involving the head, trunk, and extremities over a 4-week period. His RPR was positive (1:64), suggesting a diagnosis of rupioid syphilis. The patient was treated with doxycycline, given a reported history of penicillin allergy. Rapid plasma reagin titers decreased to 1:2 following treatment; however, the skin eruption did not improve. A biopsy of a lesion demonstrated psoriasiform acanthosis with confluent hyperkeratosis, clusters of intracorneal neutrophils, and negative spirochete immunostaining. Based on histopathology and clinical presentation, a diagnosis of rupioid psoriasis was favored. The patient was started on targeted anti-psoriatic therapy with apremilast and maintains close follow-up with his dermatologist every three months. Conclusion: Although the patient’s presentation was initially presumed to be secondary to syphilis, his lack of response to treatment prompted further workup to assess the etiology of the patient’s skin findings more accurately. In doing so, a diagnosis of rupioid psoriasis was favored based on the histologic findings observed.

This study aims to quantify the relationship between economic disadvantage and access to dermatological care in Florida in order to advocate for tailored healthcare policies. Identifying underserved geographic communities can guide policymakers in implementing strategies to enhance accessibility to care in these areas. Using data from the Centers for Medicare & Medicaid Services (CMS) and the US Census, this study analyzed dermatologist density across 920 Florida zip codes. Economic disadvantage was assessed using the distressed community index (DCI), a metric that stratifies zip codes into 5 levels of economic well-being. Statistical analyses, including the Kruskal-Wallis test, were conducted to assess disparities. Findings revealed significant differences in the number of providers by DCI quintile (p<.001) and urban/rural designation (p<.001). Lower deprivation areas were more likely to have providers, with 33.2% of the least deprived quintile having at least one provider compared to 11.8% in the most deprived quintile. Urban areas were more likely to have at least one provider (p<.001), with 36.6% of urban zip codes having providers versus 1.1% of rural ones. Zip codes with at least one provider had significantly higher total population (p<.001). These findings highlight the need for targeted interventions to address geographic disparities in the provision of dermatologic care, particularly in economically disadvantaged and rural areas of Florida. Considering the state’s high sun exposure rates and associated skin cancer risks, ensuring accessible dermatology services across all zip codes, regardless of socioeconomic status, is imperative for public health.